Association of Gangrenous, Suppurative, and Exudative Findings With Outcomes and Resource Utilization in Children With Nonperforated Appendicitis.

Autor:	Cramm SL; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Lipskar AM; Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York., Graham DA; Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts., Kunisaki SM; Division of General Pediatric Surgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, Maryland., Griggs CL; Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Allukian M; Division of Pediatric, General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Russell RT; Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham., Chandler NM; Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida., Santore MT; Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia., Aronowitz DI; Division of Pediatric, General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Blakely ML; Department of Surgery, Vanderbilt Children's Hospital, Vanderbilt School of Medicine, Nashville, Tennessee., Campbell B; Department of Surgery, Connecticut Children's Hospital, Hartford., Collins DT; Department of Surgery, Children's National Hospital, Washington, DC., Commander SJ; Department of Surgery, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, North Carolina., Cowles RA; Department of Pediatric Surgery, Yale New Haven Children's Hospital Yale School of Medicine, New Haven, Connecticut., DeFazio JR; Division of Pediatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos Colleges of Physicians and Surgeons, New York., Echols JC; Division of Pediatric Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill., Esparaz JR; Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham., Feng C; Department of Surgery, Children's National Hospital, Washington, DC., Guyer RA; Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Hanna DN; Department of Surgery, Vanderbilt Children's Hospital, Vanderbilt School of Medicine, Nashville, Tennessee., He K; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Kahan AM; Division of Pediatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos Colleges of Physicians and Surgeons, New York.; Department of Surgery, Mount Sinai Health System, New York, New York., Keane OA; Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia., Lamoshi A; Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York., Lopez CM; Division of General Pediatric Surgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, Maryland., McLean SE; Division of Pediatric Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill., Pace E; Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Regan MD; Department of Surgery, Connecticut Children's Hospital, Hartford., Scholz S; Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Tracy ET; Department of Surgery, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, North Carolina., Williams SA; Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida., Zhang L; Department of Pediatric Surgery, Yale New Haven Children's Hospital Yale School of Medicine, New Haven, Connecticut., Rangel SJ; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2022 Aug 01; Vol. 157 (8), pp. 685-692.
DOI:	10.1001/jamasurg.2022.1928
Abstrakt:	Importance: The clinical significance of gangrenous, suppurative, or exudative (GSE) findings is poorly characterized in children with nonperforated appendicitis. Objective: To evaluate whether GSE findings in children with nonperforated appendicitis are associated with increased risk of surgical site infections and resource utilization. Design, Setting, and Participants: This multicenter cohort study used data from the Appendectomy Targeted Database of the American College of Surgeons Pediatric National Surgical Quality Improvement Program, which were augmented with operative report data obtained by supplemental medical record review. Data were obtained from 15 hospitals participating in the Eastern Pediatric Surgery Network (EPSN) research consortium. The study cohort comprised children (aged ≤18 years) with nonperforated appendicitis who underwent appendectomy from July 1, 2015, to June 30, 2020. Exposures: The presence of GSE findings was established through standardized, keyword-based audits of operative reports by EPSN surgeons. Interrater agreement for the presence or absence of GSE findings was evaluated in a random sample of 900 operative reports. Main Outcomes and Measures: The primary outcome was 30-day postoperative surgical site infections (incisional and organ space infections). Secondary outcomes included rates of hospital revisits, postoperative abdominal imaging, and postoperative length of stay. Multivariable mixed-effects regression was used to adjust measures of association for patient characteristics and clustering within hospitals. Results: Among 6133 children with nonperforated appendicitis, 867 (14.1%) had GSE findings identified from operative report review (hospital range, 4.2%-30.2%; P < .001). Reviewers agreed on presence or absence of GSE findings in 93.3% of cases (weighted κ, 0.89; 95% CI, 0.86-0.92). In multivariable analysis, GSE findings were associated with increased odds of any surgical site infection (4.3% vs 2.2%; odds ratio [OR], 1.91; 95% CI, 1.35-2.71; P < .001), organ space infection (2.8% vs 1.1%; OR, 2.18; 95% CI, 1.30-3.67; P = .003), postoperative imaging (5.8% vs 3.7%; OR, 1.70; 95% CI, 1.23-2.36; P = .002), and prolonged mean postoperative length of stay (1.6 vs 0.9 days; rate ratio, 1.43; 95% CI, 1.32-1.54; P < .001). Conclusions and Relevance: In children with nonperforated appendicitis, findings of gangrene, suppuration, or exudate are associated with increased surgical site infections and resource utilization. Further investigation is needed to establish the role and duration of postoperative antibiotics and inpatient management to optimize outcomes in this cohort of children.
Databáze:	MEDLINE
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